348 Alhambra Circle, Coral Gables (305) 447-9199 dentistry@lesliehallerdmd.com
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# Your child’s airway shapes everything.

How a child breathes during their growing years determines the shape of their face, the width of their jaw, the quality of their sleep — and the trajectory of their development. The earlier we intervene, the more we can change.

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1 in 4
children has sleep-disordered breathing
90%
of facial growth occurs before age 12
Fix before 6
the new standard — don’t wait until 9 or 10
No surgery
non-surgical approach for all ages
01
Early treatment prevents a lifetime of problems
Ninety percent of facial growth occurs before age 12. Intervening while the jaw is still developing is dramatically more effective — and far less invasive — than treating the result in adulthood.
02
Many ADHD diagnoses are airway problems
A child who can’t breathe well at night can’t sleep well. A child who can’t sleep well can’t learn, focus, or regulate emotions. Treating the airway often transforms behavior — without medication.
03
Mouth breathing reshapes a child’s face
Chronic mouth breathing narrows the palate, lengthens the face, crowds the teeth, and reduces airway space. These are not just cosmetic concerns — they are structural changes with lifelong health consequences.
04
Surgery is not the only option
Enlarged tonsils, crowded teeth, narrow arches — these are commonly treated with surgery or extractions. In many cases, addressing the airway root cause with non-surgical methods can achieve better long-term results.
Infants & Newborns

## The first weeks matter more than most parents realize.

Airway development begins at birth — and problems that start in newborns can shape a child’s jaw, face, and breathing patterns for life. The good news: this is also the easiest time to intervene.

Signs to watch for in newborns

- Difficulty latching or maintaining latch
- Clicking or smacking sounds while nursing
- Reverse swallow — tongue thrusting forward
- Excessive fussiness, colic, reflux
- Poor weight gain despite frequent feeding
- Reluctance to sleep on back
- Snoring or noisy breathing during sleep
- Mouth breathing from birth
- Asymmetrical head shape or strong head-turning preference

The reverse swallow — commonly missed
A tongue that thrusts forward with every swallow is not evidence of a free tongue — it is a tongue compensating for a restriction. Many healthcare practitioners miss this. If you’ve been told your baby doesn’t have a tongue tie but breastfeeding is painful or difficult, a second opinion is warranted.
Tongue tie — the upstream cause
A tongue tie restricts the tongue’s range of motion from birth. It affects latch, feeding efficiency, sleep position, and the development of the palate and jaw. Dr. Haller evaluates every infant for tongue and lip tie — including posterior ties that are commonly overlooked on visual exam. Releasing a tongue tie early is the most impactful intervention we can make.
Breastfeeding support
Dr. Haller works in coordination with lactation consultants throughout South Florida. We recommend a lactation consultation before and after any tongue tie release. A release alone is not always sufficient — proper swallow retraining is essential for future development.
Dr. Haller’s recommendation from 6 months
Myo Munchee Bebe — day and all night
Once a baby begins teething — around 6 months — Dr. Haller highly recommends the Myo Munchee Bebe, even if no tongue tie release has been performed. Teething infants love to chew, which makes this the perfect time to introduce it. The Bebe is worn day and night and works in three ways:

- Encourages chewing — stimulating jaw development and arch shaping from the earliest age
- Promotes nasal breathing during sleep — if the baby keeps it in, they are breathing through their nose all night
- Gets the baby accustomed to wearing an appliance — making it easy to upgrade to progressively larger appliances as they grow. Starting early is the key. Trying to introduce a nighttime appliance to an older child who has never worn one is dramatically harder.

This is one of the most impactful — and simplest — things a parent can do to support their child’s airway development. The habits established in infancy set the foundation for everything that follows.
Toddlers & Young Children · Ages 2–7

## The window of greatest opportunity.

Between ages 2 and 7, the jaw and palate are highly responsive to gentle guidance. This is the ideal time to establish nasal breathing, correct tongue posture, and begin guided arch development — before structural patterns become fixed.

Signs parents often overlook

- Mouth breathing — lips apart at rest, during sleep
- Snoring — any snoring in a young child warrants evaluation
- Enlarged tonsils or adenoids
- Restless sleep, night terrors, frequent waking
- Bedwetting beyond expected age
- Speech delay or difficulty with certain sounds
- Picky or slow eating
- Hyperactivity, inattention, behavioral problems
- Dark circles under eyes (“allergic shiners”)
- Mouth open, tongue low and forward at rest

Is it ADHD — or is it the airway?
Many toddlers and young children diagnosed with behavioral problems, inattention, or ADHD are actually experiencing chronic sleep deprivation from airway obstruction. A child who mouth breathes all night, snores, and wakes repeatedly is not getting restorative sleep. The behavioral consequences are often indistinguishable from ADHD. Treating the airway can be transformative — and Dr. Haller evaluates for this connection at every consultation. For parents who want to go deeper, Dr. Haller recommends Sleep-Wrecked Kids by Sharon Moore.
“Fix before six” — the new standard in pediatric airway care
For generations, parents were told to wait until a child was 9 or 10 before starting orthodontic treatment — after most of the permanent teeth came in. We now know this is far too late. The jaw is most responsive to guidance in the early years. Depending on the child, traditional orthodontic expanders can be used as young as age 3 or 4. Functional appliances, habit correctors, and targeted expansion done before age 6 can change a child’s developmental trajectory entirely — often eliminating dental crowding and the need for more invasive treatment later.
What we can do at this age

- Evaluate and release tongue and lip ties
- Begin functional appliances such as the Healthy Start habit corrector — using the muscles of the tongue, cheeks, and lips to gently shape the dental arches, establish nasal breathing, and guide jaw development
- Traditional orthodontic expanders — if needed and appropriate for the child, can be used as young as age 3 or 4
- Laser tonsil decontamination — shrinks enlarged tonsils without surgery
- Coordinate with ENT if adenoid evaluation is needed
- Myofunctional therapy referral
- Nasal breathing training and habit tools — such as the MyoMunchee or FroggyMouth

Dr. Haller’s approach
Functional appliances — such as the Healthy Start habit corrector
Functional appliances use the natural forces of the tongue, cheeks, and lips to gently shape the dental arches — guiding jaw development without force or surgery. Dr. Haller uses a range of functional appliances tailored to each child’s age and anatomy. The Healthy Start habit corrector is a soft, comfortable appliance worn during sleep that positions the tongue correctly, promotes nasal breathing, and guides arch development while the child sleeps.
Children & Teens · Ages 8–17

## Crowded teeth are a symptom — not the cause.

By age 8, the consequences of an underdeveloped airway are becoming visible: crowded teeth, a narrow face, mouth breathing, difficulty concentrating. The ideal window was before age six — but meaningful improvement is very much possible through the teenage years. Dr. Haller treats the reason the crowding happened and expands the arch to make room, rather than extracting teeth to fit a small jaw.

What parents, teachers, and coaches notice

- Crowded, crooked, or overlapping teeth
- Narrow dental arch or high, narrow palate
- Mouth breathing — lips apart at rest, chapped lips
- Snoring or restless sleep
- Difficulty focusing, poor academic performance
- ADHD diagnosis — often with unaddressed airway component
- TMJ pain, jaw clicking, headaches
- Forward head posture, neck and shoulder tension
- Anxiety or depression — may have airway / sleep component
- Long, narrow face developing over time
- Frequent colds, ear infections, sinus problems

Why extractions are often the wrong answer
Traditional orthodontics frequently recommends extracting permanent teeth to make room for crowded teeth. But crowding is a symptom of a jaw that didn’t develop to its full potential — usually because of mouth breathing and low tongue posture. Extracting teeth makes the existing small arch even smaller, reducing airway space further. Dr. Haller expands the arch instead — making room for all the teeth while simultaneously opening the airway.
What is sometimes missed
Posterior tongue ties are frequently undetected into the teenage years — especially if breastfeeding wasn’t difficult. TMJ pain, chronic headaches, forward head posture, and fatigue in older children and teens are commonly attributed to stress or posture habits. In many cases the tongue tie is the origin — and releasing it, combined with myofunctional therapy and arch expansion, addresses the root.
What we can do — ages 8 through 17
Treatment is tailored to each child’s age, anatomy, and stage of development. Dr. Haller often combines approaches — using different appliances sequentially or together for the best result.

- Tongue tie evaluation and release — a step Dr. Haller frequently takes early in treatment if a restriction is identified
- Traditional orthodontic expanders — both fixed (cemented to the teeth) and removable versions, used to widen the palate and open the nasal airway
- ALF (Advanced Light Force) appliance — a gentle wire-based appliance that works with the cranial system to develop the arch and improve breathing; Dr. Haller is clinically trained in ALF therapy
- Functional appliances — continue to guide jaw development using natural muscle forces
- Clear aligners — used in finishing stages to refine tooth alignment once the arch has been adequately expanded
- Myo Munchee — builds jaw muscle strength and supports nasal breathing
- Laser tonsil decontamination — if enlarged tonsils are contributing
- Nasal Release Therapy (NRT) — opens nasal passages that may have been restricted for years
- Myofunctional therapy — retrains tongue posture and swallow pattern before and after release
- Coordination with pediatrician, ENT, speech therapist, and orthodontist

“A narrow palate is a narrow airway. When I expand the arch in a child, I’m not just straightening teeth — I’m opening the nasal passages, improving nasal breathing, and changing the entire developmental trajectory.”
— Dr. Leslie Haller, DMD
Frequently asked questions

## Questions parents ask most.

My child snores. Is that normal?
No — any snoring in a child warrants evaluation. Snoring is a sign of airway turbulence during sleep, which means the child is working harder than they should to breathe. Even mild snoring can disrupt sleep quality enough to affect behavior, learning, and growth. It is not something to wait and see on.
My pediatrician says my child’s tonsils need to come out. Is there another option?
Often, yes. Laser tonsil decontamination can significantly reduce tonsil size in many children without surgery, anesthesia, or recovery time. Dr. Haller coordinates directly with ENTs throughout South Florida. If you’ve been referred for tonsillectomy, it’s worth exploring laser treatment first — surgery remains available if needed, and nothing is lost by trying.
My child has crowded teeth. The orthodontist recommended extractions. Should I get a second opinion?
Yes. Crowded teeth in a child are almost always a sign of an underdeveloped jaw — which is usually the result of mouth breathing, low tongue posture, or an undetected tongue tie. Extracting teeth makes the existing small arch even smaller and the airway more constricted. Arch expansion creates room for all the teeth while simultaneously opening the airway. The two approaches have very different long-term consequences.
My child was diagnosed with ADHD. Could the airway be involved?
Absolutely — and this is one of the most important questions a parent can ask. Children with sleep-disordered breathing are chronically sleep-deprived, and the behavioral symptoms are often indistinguishable from ADHD: inattention, hyperactivity, impulsivity, emotional dysregulation. A full airway evaluation before — or alongside — any ADHD treatment is strongly warranted.
How young can you start treatment?
Tongue tie releases can be performed from the first days of life. Functional appliances such as the Healthy Start habit corrector can begin around age 2. Traditional and functional expanders are typically introduced between ages 3 and 7, when the jaw is most responsive — the new standard is “fix before six.” There is no age too young to evaluate.
Does insurance cover these treatments?
Our practice is fee-for-service. We provide a Letter of Medical Necessity and insurance codes for submission to your insurer. Some medical plans cover tongue tie release — particularly with documented breastfeeding difficulty or speech impairment. Orthodontic and expansion appliances are generally not covered by medical insurance, though some dental plans may apply. We are happy to discuss at consultation.
My child’s doctor hasn’t mentioned any of this. Why?
Airway-focused dentistry is a relatively new and rapidly evolving field. Most medical and dental training programs don’t yet include detailed instruction on mouth breathing, tongue tie, or the connection between oral anatomy and airway development. This is a specialized area that benefits from a provider who focuses on it exclusively. Dr. Haller works closely with pediatricians and is always happy to communicate with your child’s doctor directly — collaboration is how the field advances and how children get the best care.
Is your child’s airway holding them back?
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